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Thoughts on "planned home births are associated with double to triple the risk of infant death... - Page 4

post #61 of 394

I really don't think that high school education is necessary for training, nor is university necessarily the correct approach. But I do believe that regulation and ensuring a high level of education is important, in the sense that midwives who train are taught the appropriate information and ensured to have the required competency to practice. There are some great programs in the USA for becoming a midwife, that are not at a university but are incredibly indepth and comprehensive. And there are some really basic programs as well that I really hope people use as their sole education (though I know some do). You also have to remember that here in Canada, while midwifery is a university education, 2.5 years of that 4 year education is focused on clinical learning. Students still do a few courses per semester but the focus is on clinical experience.

 

Great discussion guys, it is really refreshing seeing a debate that does not dissolve into arguments and insults!

post #62 of 394

I didn't mean to sound defensive; also, was responding to two separate posts in one and probably should have clarified. :)

I think midwives here (in the US) tend to be adversarial out of reaction to an adversarial attitude toward them (and homebirth).  In many places, if you transfer into the hospital, or if you go into the hospital for something else during your pregnancy, and they find out you're planning a homebirth, you're treated like a third-class citizen. 

 

I hate that there is not a "stepped" set of options.  I fully believe that a woman should be able to plan an unassisted birth, knowing that if she needs additional help when labor rolls around, she can call on a midwife, and if she still needs help, she can call on a doctor.  Essentially, that's the traditional way of doing things.  Women didn't all used to call doctors to deliver their babies.  They just - had babies - generally with other women around them, but not necessarily "qualified midwives." If they needed more help, they called in the local "wise woman," who *did* have more knowledge/experience.  And as a last resort, if necessary, they called on a doctor.  But liability keeps this from being an option anymore.  You pretty much have to choose your highest level of intervention from the start.  (That's not an absolute.  But generally speaking.)

 

And I totally agree about so much being pharma-company-driven that it's hard to find studies, papers, etc. that are unbiased.  Even the "other side" then tends to be biased because of a strong felt need to prove their point.

post #63 of 394

A2JC4life

And why is there a hostile attitude towards midwives? Or, is it just some midwives.

I am a midwife with a birth center/home birth practice. I have no problem sending my clients to the hospital during the pregnancy or during labor. For the AP trips to the hospital I will sometimes get a call from the ER doc letting me know what's going on and if there is anything else I would like done. Sometimes there are dumb questions or comments from nurses, and occasionally doctors, that the clients tell me about, but nothing hostile.
 

It may be because I tell the clients that if we need to transfer in , it will be because the hospital can do something I can't, or because the baby and mom need a bit closer watch than is appropriate OOH. If we go in being respectful and truthful, we may get a doc who starts out hostile, but realizes we aren't being adversarial and defensive. Then they relax and it can be a really good experience. The docs learn that all OOH birth midwives and families all want what is best for the mom and baby and the families learn that hospitals are not evil places forcing unwarranted interventions. I always introduce myself, take full responsibility for the care provided and truthfully answer all the questions needed so the staff has the history they need to help the family make the best decisions they can.

 

Been an OOH midwife for more than 10 years and I see things getting better in terms of hospital acceptance for the parent's wishes when we do have to transfer in.

post #64 of 394
Quote:
Originally Posted by starrlamia View Post

 

Great discussion guys, it is really refreshing seeing a debate that does not dissolve into arguments and insults!

 I think that has to do with the quality of the people participating ;)

post #65 of 394
I have a long time frIend who emagrated to Ontario. She was a self- study apprentice trained midwife who was licensed here and had lived in several other states and became licensed in those states as well. She called and talked directly to the people managing the bridge system and she was accepted into that pathyway of being licensed so basically she had to learn the hospital side of things and is now a LM in Ontario. It is still adversarial and they artifically keep the number of midwives down because doctors are so unhappy with having to support midwifery care. The way they keep the numbers down is very subitle-the hours of work/on call number counter is a limited set so if you actually do more hours there is no way to report it, and all the midwives that serve home or hospital do more hours than the counter allows- if they would remedy that there would be more midwives. And there are things like if you s transfer a mom in for pain meds the midwife administers them and then stays to be the labor nurse - doctors have labor nurses they dont have to labor sit... Midwives are on their own- these are the subitle ways that they fight against midwifery care... There are some obvious ways too but it is like here case by case. And they can have similar EMS fiascios...

It is to say that you may not have to have a degree if you have enough experience- and you take some college accredited classes then do their bridge program-
Here we already have CNMs established as hospital midwives and they are moving toward a doctorate education base-if CPMs were to bridge like the gals in Canada did it would undercut their educational base and the power behind it... I just think of CPM and some LM educational pathways as being the vocational tech school of midwifery- a CNM when in nursing school gets an hour or 2 of didatic education on pregnancy and birth so no wonder that they need more schooling to become a midwife- many many more hours of education directed toward maternal and child health- unfortunately because they are " degreed" programs you are writing English papers too and so then again stretches out the number of hours it will take to actually study the core subjects . There is a reason that RN programs dont move away from jr colleges and that is because the level of training is just as good if not better with those quick programs as far as learning the basics- i am saying that 2-3 years would probably suffice if we were to support a vocational education in Midwifery instead of a higher degreed program. My friend that is in Canada she didnt ahve to learn anything new about midwifery what she had to learn was medicine- like how to monitor an epidural... And she wants to stay as far from that as possible-
post #66 of 394

mwherbs,   When you mention the OB portion of a nursing program, what is your reference for the didactic of 1-2 hours regarding pregnancy and birth?
 

post #67 of 394
I think midwives here (in the US) tend to be adversarial out of reaction to an adversarial attitude toward them (and homebirth). In many places, if you transfer into the hospital, or if you go into the hospital for something else during your pregnancy, and they find out you're planning a homebirth, you're treated like a third-class citizen.

That post makes me sad. In my community home birth transfers are treated very well. I live in a state where midwives don't have to throw their clients out at the er bc they are afraid of punishment. I have dreams about women having the ability to feel safe about wherever they give birth. I am afraid though that this will remain a dream for a lot of women in our country (the US). The truth is we don't need studies to tell us that hospitals need to stop using unnecessary intervention and that hb mw need better practice standards. Women need to do the best research they can in their area. If my only option was a hospital with a 40% cesarean rate, bet your butt I would be looking for a midwife. If my only option was a backroom mw, w/o good credentials my choice would be to find the best hospital possible. We can't categorize hb in the US at all, there are too many variables.
post #68 of 394

"I fully believe that a woman should be able to plan an unassisted birth, knowing that if she needs additional help when labor rolls around, she can call on a midwife, and if she still needs help, she can call on a doctor."

 

I believe that this is the way that things are supposed to ideally work in the UK -- they have their homebirth option, midwife led units and consultant led units. 

 

However, it is not a perfect world over there as there have been some reports of "turf issues" with midwives unwilling to transfer patients to consultant led units as the patient's risk profile changes.  Additionally, while I am not in the UK myself, I have been on enough "mommy boards" that I have seen women located in the UK complaining about the difficulty of getting an epidural on request.  I believe that an epidural would, in the UK, require transfer of the patient from a midwife lead unit to a consultant lead unit -- so I have some suspicions that there may be midwives attempting to delay/interfere with epidural requests in order to retain the patient in the midwife unit.

 

I'll see if I can dig up some of the reporting on this...

post #69 of 394

Well, my husband has also pointed out, in the hospital personnel's defense, that for most of them, the only "homebirths" they've ever seen are the ones that resulted in transfers!  So their experience with homebirth is typically that it's "bad," dangerous, or "doesn't work."

 

We are actually hoping that we helped with this perception at our local hospital, when we came in with preterm labor at 29 weeks.  We'd had 2 homebirths already - with perfectly healthy babies - and were planning a homebirth with this third, but went in to the hospital when the preterm labor began.  This not only allowed them to see that our older girls were safe and healthy, but that we were obviously not opposed to medical care when we felt it warranted.  I don't think they get to see that much.  (And they were able to stop my labor, I carried to term, and we delivered at home - and took baby back in to visit "her" nurses. :) )
 

post #70 of 394
Quote:
Originally Posted by mwherbs View Post

I have a long time frIend who emagrated to Ontario. She was a self- study apprentice trained midwife who was licensed here and had lived in several other states and became licensed in those states as well. She called and talked directly to the people managing the bridge system and she was accepted into that pathyway of being licensed so basically she had to learn the hospital side of things and is now a LM in Ontario. It is still adversarial and they artifically keep the number of midwives down because doctors are so unhappy with having to support midwifery care. The way they keep the numbers down is very subitle-the hours of work/on call number counter is a limited set so if you actually do more hours there is no way to report it, and all the midwives that serve home or hospital do more hours than the counter allows- if they would remedy that there would be more midwives. And there are things like if you s transfer a mom in for pain meds the midwife administers them and then stays to be the labor nurse - doctors have labor nurses they dont have to labor sit... Midwives are on their own- these are the subitle ways that they fight against midwifery care... There are some obvious ways too but it is like here case by case. And they can have similar EMS fiascios...

It is to say that you may not have to have a degree if you have enough experience- and you take some college accredited classes then do their bridge program-
Here we already have CNMs established as hospital midwives and they are moving toward a doctorate education base-if CPMs were to bridge like the gals in Canada did it would undercut their educational base and the power behind it... I just think of CPM and some LM educational pathways as being the vocational tech school of midwifery- a CNM when in nursing school gets an hour or 2 of didatic education on pregnancy and birth so no wonder that they need more schooling to become a midwife- many many more hours of education directed toward maternal and child health- unfortunately because they are " degreed" programs you are writing English papers too and so then again stretches out the number of hours it will take to actually study the core subjects . There is a reason that RN programs dont move away from jr colleges and that is because the level of training is just as good if not better with those quick programs as far as learning the basics- i am saying that 2-3 years would probably suffice if we were to support a vocational education in Midwifery instead of a higher degreed program. My friend that is in Canada she didnt ahve to learn anything new about midwifery what she had to learn was medicine- like how to monitor an epidural... And she wants to stay as far from that as possible-

actually that depends completely on the hospital, each hospital sets their own policies when it comes to midwives. Also not every doctor is upset with supporting midwifery care. Midwives have a "counter" to help with burnout and for allowing safe practices. For instance if you are up 24 hours you are to have a mandatory 8 hours off (I think its 8) because they recognize that after so much time working you may not be making as sound choices due to sleep deprevation. Most of what you stated entirely depends on the hospital, in some areas midwives have full scope of practice in regards to induction and epidurals.

post #71 of 394
Quote:
Originally Posted by Buzzbuzz View Post

"I fully believe that a woman should be able to plan an unassisted birth, knowing that if she needs additional help when labor rolls around, she can call on a midwife, and if she still needs help, she can call on a doctor."

 

I believe that this is the way that things are supposed to ideally work in the UK -- they have their homebirth option, midwife led units and consultant led units. 

 

However, it is not a perfect world over there as there have been some reports of "turf issues" with midwives unwilling to transfer patients to consultant led units as the patient's risk profile changes.  Additionally, while I am not in the UK myself, I have been on enough "mommy boards" that I have seen women located in the UK complaining about the difficulty of getting an epidural on request.  I believe that an epidural would, in the UK, require transfer of the patient from a midwife lead unit to a consultant lead unit -- so I have some suspicions that there may be midwives attempting to delay/interfere with epidural requests in order to retain the patient in the midwife unit.

 

I'll see if I can dig up some of the reporting on this...

it would require a consultant but midwives would still lead the woman's care. Transfer of care in the UK almost always means that doctors are consulted and not that midwives are no longer involved.

post #72 of 394

How many newborns would the average midwife deliver a year if they weren't limited or regulated?

post #73 of 394
Most transfers are non emergic. They are for pain medication, failure to progress and poor presentation. True emergency transfers are not what docs commonly see. The most recent ACOG statement on homebirth chastised doctors for being unprofessional with transfers.
post #74 of 394

For example,

 

"Gas and air, water and morphine are all available on the MLU. Epidural is not, but can be obtained if necessary downstairs in the CLU. If we had any concerns about you or your baby during your labour, you would be transferred downstairs to the CLU."

 

http://www.enherts-tr.nhs.uk/patients-visitors/our-services/maternity/midwife-led-unit/

 

In a "midwife led unit" as the name indicates, primary professional responsibility lies with the midwifes.  Upon transfer to a consultant led unit, the OB assumes primary professional responsibility (while others remain involved in care).  What I am concerned about is the battle for "control".

 

This is one example of the sort of turf war I mentioned earlier (please note, story involves a number of baby deaths and includes pictures):

 

http://www.dailymail.co.uk/news/article-2038746/Midwives-ignored-doctors-instructions-scandal-hit-Cumbria-maternity-unit.html

post #75 of 394
Quote:
Originally Posted by Buzzbuzz View Post

 

This is one example of the sort of turf war I mentioned earlier (please note, story involves a number of baby deaths and includes pictures):

 

http://www.dailymail.co.uk/news/article-2038746/Midwives-ignored-doctors-instructions-scandal-hit-Cumbria-maternity-unit.html

Here is a better link for this story, which deals with hospital birth doctors and midwives. I don't see how this is relevant to a discussion about homebirth, unless we are talking about some of the advantages of HB over hospital birth. 

post #76 of 394

I'll be honest, I couldn't bring myself to read the article, not because I choose to close my eyes to information, but because the daily mail is just a tabloid.... one of today's other headlines: 'Drunk man punched girlfriend's father and bit a boat captain after getting caught having sex in the bathroom on a cruise' lol

post #77 of 394

I had a great "easy" pregnancy.  I was well taken care of seeing a midwife and an OB that I started with before I decided I really wanted a home birth.  Everything was normal the whole time.  Labor was great and fairly quick from what I am hearing.  During the home birth me and the baby were checked and monitored  (fever, BP, fetal heart tones...) and again all was great.  However, my little angel did not breath after delivery.  I was not that scared right away.  I was very prepared and saw lots of videos and knew that if could take a few seconds. Seconds turned to minutes and she never took a breath.  Ambulance was called and they arrived in minutes. It was all too long for my daughter and she lasted a week at the hospital on every type of machine to keep her different, delicate systems functioning.  It was a horrible experience and as much as I would love to experience giving birth in the comfort of my home and to be able to snuggle with my child and husband in our own bed in our home after delivery.  I could never chance it again and I could never recommend it to someone else.  Again, my pregnancy and delivery were very normal and uncomplicated, until she was born.  And I still have no real answers as to what happened.

post #78 of 394
Quote:
Originally Posted by knoel View Post

I could never chance it again and I could never recommend it to someone else.  Again, my pregnancy and delivery were very normal and uncomplicated, until she was born.  And I still have no real answers as to what happened.

Totally understandable, mama, and I'm so sorry for your loss, especially as a fellow Baltimore area mother. PM me if you need/want any local support. heartbeat.gif

post #79 of 394
Quote:
Originally Posted by Escaping View Post

How many newborns would the average midwife deliver a year if they weren't limited or regulated?

I don't know but midwives can do up to 60 births a year, plus the ones they do secondary for and any backup they provide. As a future midwife I cant imagine attending more than 8-9 births a month on top of prenatal and postpartum care. Our midwives already experience a high level of burnout being on call as they are.

post #80 of 394
Quote:
Originally Posted by starrlamia View Post

I don't know but midwives can do up to 60 births a year, plus the ones they do secondary for and any backup they provide. As a future midwife I cant imagine attending more than 8-9 births a month on top of prenatal and postpartum care. Our midwives already experience a high level of burnout being on call as they are.

That's what I had heard too, I just wasn't sure if it was correct. Also, as with any profession, I'm sure you're expected to devote a certain amount of time for professional development. 

 

At 60 babies and $2,500 per baby, it doesn't really seem to me that the government would be squeezing midwives out of the system. There aren't many professions in Canada which take 4 years of university where you're almost guaranteed a job and paid that kind of money. If it's something you enjoy doing (you couldn't pay me a zillion dollars a year to deliver babies! lol) it seems like a pretty good deal to me. 

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